Office treatment of large endometrial polyps using truclear 5C: Feasibility and acceptability

Abstract

Aim: This retrospective multicenter study was carried out to evaluate feasibility, effectiveness and patient acceptability of a small diameter hysteroscopic tissue removal system in the treatment of large endometrial polyps (≥20 mm), usually not removed in an office setting. Methods: Hundred and forty-six women with a single greater than 10-mm diameter polyp considered for polypectomy between April 2016 and August 2017. Sixty-five of these patients had a polyp size greater than 20 mm. All hysteroscopic polypectomy, using Hysteroscopic Tissue Removal system (TruClear 5C System Medtronic), were performed in an office setting with vaginoscopic approach. Results: Procedural success, time to complete the polypectomy and patient pain scores were evaluated. Polyps less than 20 mm were completely removed in 79/81 cases (97.53%). The completeness of greater than or equal to 20-mm polyp removal was achieved in 63/65 cases (96.92%). The median time for polypectomy was 4.19 AE 1.03 min for polyps less than 20 mm and 4.97 AE 1.30 min for polyps greater than or equal to 20 mm, respectively. Pain was minimal and brief, and the mean pain score measured on a 10-point visual analog scale at the end of polypectomy showed no significant difference between the two groups. In 4/79 (5.06%) cases with polyps less than 20 mm and in 4/63 (6.35%) cases with polyps greater than or equal to 20 mm women reported moderate pain. All specimens were adequate for pathologic measurements. Conclusion: Hysteroscopic treatment of polyps greater than or equal to 20 mm in size with TruClear 5C is feasible and well tolerated in an office setting with no significant difference regarding completeness compared to polyps less than 20 mm, but with a minimal increase in procedure times.

Comparison of endometrial polyp recurrence in fertile women after office hysteroscopic endometrial polypectomy using two widely spread techniques

“…In this study, we evaluated the recurrence of endometrial polyps after hysteroscopic polypectomy performed in an office setting by skilled surgeons with two widely used techniques, BE and HTRs that allow, under vision, to cut or remove the polyp at the base preserving at the same time the surrounding endometrium and avoiding deep injury to the myometrium to prevent the formation of intrauterine adhesions 5,8 …”

“…The significant difference in operative time linked more to additional maneuvers necessary to retrieve fragments with forceps from the uterine cavity than to surgeon skill because the surgeon (E. C.) had been performing hysteroscopic polypectomy using BE during last 20 years. Moreover, the reduced operative time with HTRs was linked more to the simultaneous cutting and removal of tissue through the active blade suction than to surgeon's experience 8,20,21 …”

“…All polyps removed at 1‐year follow‐up were confirmed as ‘benign’ by the pathologist. Despite the effects of tissue fragmentation, the removal of endometrial polyps using HTRs provided adequate tissue for pathological diagnosis, not decreasing the likelihood of identifying abnormal endometrial polyp disease 8,13,25 …”

“…This new technology simultaneously cuts and removes the tissue improving visibility and reduces the need for multiple equipment insertions. Since 2012 the use of a small HTRs (5.6 mm in diameter) (TruClear 5C System, Medtronic) has been shown to be effective, fast and easily learned and recently, large endometrial polyps (≥2 cm) have been treated in an office setting 8 …”

A Mini-Review of Office Hysteroscopic Techniques for Endometrial Tissue Sampling in Postmenopausal Bleeding

“…The overall diameter of TruClear 5C is 5.6 mm, and the optic size is 0.8 mm. [ 53 ] The mechanism of action is rotation and reciprocation [ Figure 4 ]. TruClear Elite comes with a rod lens optic with an overall diameter of 6 mm and an optic size of 1.9 mm.…”